What factors influence young women's choice of contraception?
The oral contraceptive pill (OCP) is still the contraceptive method of choice for most young women. Their use of, and views on, hormonal contraceptives: the OCP, progestogen-only pill and progestogen injection were explored in a qualitative study.
The 20 participants were selected from a sample of a randomised trial of a school-based sex education intervention. They were invited by letter to be interviewed at the age of 20. A purposive technique was used to select a heterogeneous group of young women with different levels of sexual experience, social backgrounds, areas of residence, and educational attainment.
The in-depth interviews lasting around an hour took place, using a topic guide, in women's own homes. The interviews were tape recorded and the transcripts were analysed based on grounded theory.
All but one of the interviewees had used the OCP. Only four had used other hormonal contraceptive methods and then only after experiencing problems with the OCP. All four discontinued these alternative methods because they disliked the absence of monthly periods or because of weight gain.
The authors divided the themes of discussions into push and pull factors relating to OCP use and alternative hormonal contraceptives.
For the OCP, the push factors encouraging use included: greater efficacy and safety; non-contraceptive effects; expectation of use with sexual partners and accessibility.
The pull factors discouraging use were: side-effects; forgetting to take pills or running out of pills and not being sexually active.
For the alternative hormonal methods, the push factors included: side-effects with the OCP and healthcare practitioner influence.
The pull factors were: experience and dislike of side-effects and negative experience of others.
NICE guidelines, published in 2005, encourage the use of LARC.1 However, most young women still rely on the OCP as their main method of contraception.
In order for women to take up and continue with any method of contraception, an honest discussion about the expectations and management of side-effects is key.
Williamson LM, Buston K, Sweeting H. Young women's continued use of oral contraceptives over other hormonal methods: findings from a qualitative study. J Fam Plann Reprod Health Care 2009; 35(3): 167-172Reviewer
Dr Richard Ma
GP Principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London